We help business owners navigate Missouri workers' comp rules.

The Missouri Division of Workers Compensation administers workers compensation in the state of MO. We have provided access to helpful MO forms and guides including injury report notices for claims, Acord applications for purchasing workers comp, owner election forms, and our employer handbook for Missouri workers compensation.

We make ever effort to keep our forms library current with the most recent forms and documents and are always happy to help employers locate any form related to their policy. Call us today at 888-611-7467 for a free, no-obligation workers compensation insurance quote in Missouri.

Missouri Workers Compensation Insurance Forms

MO Acord 130 Workers Compensation Application

The standard Acord 130 application form for workers comp coverage in Missouri.

Missouri First Report of Injury Form

MO First Report of Injury Form.  Employers should complete this form and send to their insurance company each time an injury occurs.

Missouri Application for Exclusion of Officers and Stockholders

Owners and Officers of corporations should complete this form to exclude themselves from a work comp policy.

MO Affidavit of Exemption for Workers' Compensation Insurance

Complete this form if you are a sole-proprietor or partnership with no employees and would like to be exempt from coverage.

Missouri LLC Rejection of Workers Compensation Coverage

This form allows LLC members to reject workers comp coverage for the state of Missouri.

Fact for Injured Workers In Missouri

Information about workers compensation in Missouri for Injured Workers.

Handbook on Missouri Workers Compensation Law

A 2010 publication for employees that provides answers about MO laws pertaining to injuries.

Missouri Medical Treatment Form WC-9 for Workers Compensation

Medical treatment form for the Missouri Division of Workers Compensation.

MO Notice of Commencement/Termination of Compensation

The form includes instruction designed to help calculate the lost time benefits for employees.

Guide to the Missouri Second Injury Fund

A publication by the MO Division of Workers Compensation about the states Second Injury Fund.

Work Comp Claim Instruction and Form WC-21-3

Claim for Compensation Form and instructions for filing a MO claims the State.

MO Dept of Labor State Average Weekly Wage and Benefit Maximums

Effective July, 2011, the state of MO has detailed changes to the state average weekly wage used to determine workers compensation benefits.

Workers' Comp Exemption

Each state has its own laws and requirements regarding when and how employers are allowed to opt-out of coverage under their workers compensation policy. Some states make it easier than others because they don't require anything to be filed. Other states require special inclusion or exclusion affidavit documentation. Failure to comply often causes employers to have to pay premium on themselves even when they wanted to be excluded form coverage.

Waiver of Subrogation

A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business. This is common in the construction industry as builders attempt to protect their company from negligence. A workers' comp waiver of subrogation does not prevent an injured employee from filing a lawsuit for damages. This coverage typically add about $100 to the cost of a work comp policy.

Certificate of Insurance

A Certificate of Insurance is a document that serves as evidence of insurance or proof of coverage. Certificates indicate your current coverages and policy limits. Insurance Agencies issue on an insured's behalf and they often list a third party as a certificate holder. This means they should be notified if a policy cancels prior to expiration. Requests for any special wording should be carefully checked against the policy language before being added to a certificate as they can create legal issues with coverage.


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State Resources for Missouri

Missouri Department Of Insurance

301 West High Street Room 530
PO Box 690
Jefferson City, MO 65102-0690
Missouri Dept of Insurance

Missouri Department Of Labor and Industrial Relations

Division of Workers' Compensation
3315 West Truman Blvd, Room 131
PO Box 58
Jefferson City, MO 65102-0058
Jefferson City, MO 65102-0058
573-751-4231
MO Division of Workers Compensation

Workers compensation insurance is required by law for Missouri employers.

Missouri forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers compensation form your need for Missouri.

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Visit NCCI for more resources and information about workers' compensation class codes. Visit United States Department of Labor for more information about government agencies managing workers compensation insurance rates.

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